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Hair Loss: Understanding the Concept and Managing It

What is Hair Loss?

With regards to the topic for this health discussion session, it is imperative for readers to know what hair loss is. Hair loss is a condition characterized by the loss of hair from a part of the body (eg. head or hands) or the whole body.

Most times the head is implicated in the menacing effects of this disorder and victims normally experience thinning, patchiness, or baldness on the head.

Hair loss is also known as alopecia and its severity can vary from a small area of the body such as the top or temples of the head to the whole body.

According to Dr. Alan Bauman, a hair expert of the Bauman Medical Group in Florida, the risk of losing hair correlates with age.

He says, “20% hair loss can occur in your 20s, 30% in your 30s and so on, including any time after puberty”. This implies that aging is an inevitable natural cause of hair loss.

Although it is uncommon in teenagers, hair loss can be experienced as early as 15 or 16 years and it normally presents as the gradual thinning of hair and or receding hairline at such young ages.

What are the types of Hair Loss?

As we continue the discussion, it is anticipated that readers would be interested in knowing and having at least a fair understanding of the various types of hair loss.

This will be beneficial especially to those who have been victims of this defect to know which category they fall into. Below are some various types of hair loss caused by various conditions:

a.   Androgenic Alopecia:

This condition is genetic and can affect both sexes and it is normally referred to as male pattern baldness when it happens in males and female pattern baldness when seen in females.

The receding of the hairline and gradual disappearance of hair from the crown and frontal scalp are the main characteristic features of this condition. Its onset is normally as early as in the teens or early 20s.

b.    Male Pattern Baldness:

This is the most common form of baldness in males and it is also known as the permanent pattern baldness. It is caused by genetics meaning it is mostly inherited from the fathers provided they were bald.

It is age-related thus as a man grows, he is likely to experience balding if the same happened to the father.

c.   Female Pattern Baldness:

Although hair loss is more predominant in males, it can also occur in females with the most common form of hair loss being the female pattern baldness.

It is mostly characterized by the gradual thinning of hair which does not lead to a receded hairline or complete baldness as compared to that in men.

In most women, there is a uniform thinning of hair all over the scalp. From statistics conducted by the Hair Society especially on American women, it was revealed that about 21 million suffer from hair loss and by age 60, about 80 % of women globally would suffer from hair loss.

d.  Telogen effluvium:

It is a temporal condition predominant in women compared to men and involves the loss of hair two or three months after some physiological events such as hormonal imbalance that follows pregnancy, very stressful events like surgery, and being on a low protein diet.

It normally occurs all over the head and also characterized by a period of shedding which is likely to slow down and stop within 6 – 8 months of the event that triggered it.

e.  Alopecia areata

This hair loss type is an autoimmune disorder that is usually diagnosed when one or more small patches on the scalp become bald completely.

The eyebrows and eyelashes are other parts of the body that can be affected. The cure to this condition is unknown and the cause is also yet to be demystified.

Thus, one cannot help but wonder how mysterious this defect can be. However, the lifeline is that the condition often reverses itself and the lost hair can be replenished naturally although the loss of hair can recur.

What are the stages of Hair Loss?

It is also relevant for us to know the various stages of hair loss as this will be pivotal and integral in making timely efforts of managing our hair well with the right tactics before the condition worsens. According to the Hamilton-Norwood scale, there are 7 stages of hair loss based on the severity and pattern of hair loss. These are as elaborated briefly below:

·Stage 1: No significant hair loss or recession of the hairline.

·Stage 2: There is a slight recession around the temples of the hairline. It is a common feature in older adults and thus it is referred to as the mature or adult hairline.

· Stage 3: There is noticeable loss of hair at this stage and is characterized by the pulling back of the hairline from the temples to resemble a U, M or V shape. Often, the recessed areas are either bare or sparsely covered with hair. It is age related and the first signs of balding are clinically diagnosed at this stage normally.  

·Stage 3 Vertex: In stage 3 vertex balding, there is the loss of hair from the top of the scalp apart from experiencing the normal stage 3 signs as described above.

· Stage 4: The hairline recession becomes more severe at this stage. There is only a sparse amount of hair or no hair at all on the scalp and there is only a strip of hair between the receding hairline and the bald spot.

There is also the Stage 4A, where there might not be a bald spot but the loss of hair from the frontal-temporal region becomes more severe.

Stage 5: In this stage the strip of line between the bald spot and the receding hairline becomes thinner and the early signs of horseshoe-shaped hairline are noticed. This stage is a more acute progression of stage 4.

Stage 6: There is a much thinner hairline separating the two bald spots on the head and even in some cases classified as Stage 6A, the thin line disappears due to hair loss and the two bald spots conjoin to become a bigger bald spot. 

Stage 7: It is the final and most severe stage of hair loss as the horseshoe pattern, whose early signs are seen in stage 5, becomes more pronounced and prominent.

The area of horse-shoe shaped hair remains intact but the frontal, the temporal and the crown area of hair loss conjoin to form an even bigger bald spot.  

What are the causes of Hair loss?

Some factors such as age, genetics and hormonal changes are the main causes and influencers of hair loss. However, there are other causes which play a role in the predisposition to hair loss. Some of these are as highlighted below:

  •   High level of stress on the body due to surgery or serious illness.
  • Hormone imbalances especially during and after pregnancy, childbirth, menopause.
  • Vitamin deficiencies and thyroid problems.
  • Poor diet or unbalanced diet especially low protein diets.
  • Exposure to radiation.
  • Repeated trauma to the hair shaft from traction, bleaching, perming, or blow-drying normally results in abnormalities of the hair shaft in adults.
  • Fungal infections such as ringworm of the scalp and metabolic disorders.
  • Certain medications such as anticancer chemotherapy, some antidepressants, and anticoagulants (blood thinners) can also cause hair loss.

    Worth noting that hair loss can be a side effect of some medications as the above mentioned and it is, therefore, a prerequisite for individuals to be intuitive enough to be well-informed on the necessary details about their medications before administering them.

What are some of the detrimental Effects/Consequences of Hair Loss?

With references to some studies conducted over the years, especially one by D. Williamson, M. Gonzalez and A.Y. Finlay, in 2001, there were findings that hair loss resulted in;

  • loss of self-confidence,
  • heightened self-consciousness and
  • low self-esteem in the subjects affected by hair loss in their studies.

They employed the use of the Dermatology Life Quality Index (DLQI) and an adapted version of the DLQI with Financial utility questions, an abbreviated version of the Center for Epidemiologic Studies Depression Scale, and open‐ended questions in the research to obtain these findings.

This proves that the consequences of hair loss are mostly detrimental to mental health.

When to See A Professional

There is the need to seek a professional advice and help from a doctor (dermatologist) or hair expert when you observe these signs or factors as briefly stated below:

  • The pattern of your hair loss is unusual or unfamiliar.
  • There is some itching accompanying the hair loss as this is normally an indicator that there could be a possible infection that needs to be treated.

It is important to also seek professional guidance if you need help managing the psychological stress which is normally co-morbid with hair loss.

How is hair loss Treated?

There are several treatments that can help combat or slow down the progression of hair loss. Some of these are briefly explained below:

  • Removal of the cause of the hair loss if traumatically induced.
  • Using leave-on conditioners that coat the hair fibers can help to increase hair strength and prevent or decrease breakages.
  • Some drugs like minoxidil and finasteride have also been prescribed by doctors to be useful.

    • Finasteride works by inhibiting the dihydrotestosterone (DHT) hormone responsible for hair loss.
    • The exact mechanism of action for minoxidil is not so clear though it is believed to exert its effect by elongating the hair growth phase and partially enlarging the hair follicles.

      It is however worth noting that these medications are hardly a permanent solution to pattern baldness and as a matter of fact, they only temporarily slow down the hair loss process.
      Individuals who resort to such medications for the treatment of their hair loss would be required to use them in the long term to continue enjoying the benefits whilst taking important notes of the side effects of these medications such as arrhythmias or irregular heartbeats, light-headedness, weight gain, numbness of the extremities, swelling of the face amongst others.

      There is also the need to note that these drugs do not work for everyone especially for those who are already bald. They are only useful for people who are just starting to lose their hair.
  • Aldactone has also been found to be useful for hair loss in women whose hair loss is mainly due to hormonal imbalance. It aids in the restoration of the hormone balance and in the treatment of female pattern hair loss. However, there are some pros and cons to its use and thus it is important to note the side effects, drug interactions, contraindications with regards to its use before using it or recommending it for an individual to use.
  • Hormone Replacement Therapy (HRT) is also effective especially for menopausal women and women who experience hair loss after pregnancy. These hormones are made readily available in estrogen and progesterone pills and creams. Estrogen is related to hair growth in females. During pregnancy, women tend to have a lot of thick hair because the estrogen levels are very high than normal.

    However, the estrogen levels drastically decrease after childbirth and this results in the thinning of hair and hair loss. Thus, HRT is especially very useful in situations and candidates like these (during menopause and after childbirth).
  • Cimetidine (Tagamet) has a weak androgen blocking ability and is also believed to have the ability to partially block the hormone dihydrotestosterone from attacking the hair follicles. Although it is mostly prescribed for other purposes such as in the treatment of ulcers and GERD (Gastroesophageal Reflux Disease), it can also have a minor role to play in slowing down the hair loss process.
  • Sulphur is also known to be very important for the growth of hair follicles. Vegetables such as onions, garlic and also fish, eggs, high-quality beef, and poultry (grass-fed) are known to be rich sources of sulphur.
    Hence, individuals suffering from hair loss can consume more of these vegetables and foods in their diets.
  • Hair Replacement Surgery is another alternative for combating hair loss although it is not an ideal solution for everyone suffering from hair loss. Those with inflammatory diseases such as lupus or psoriasis are not good candidates for this method. Those with hair loss all over their head would also lack the good donor site for the hair transplant to be effectively conducted.

The above are amongst the techniques resorted to by many over the years to combat hair loss and thus there is the need for individuals to assess their conditions to know which method would best meet their needs without causing further health discrepancies.

Management for hair loss

Both men and women can hide their hair loss by styling their hair with a comb such that the areas of thin hair or bald spots can be covered. The men can as well have an appropriate haircut with the right shaping of their hairline to help minimize the shedding to the U, V or M shape hairline which normally precedes balding.

Women can hide their hair loss with hair pieces and wigs to add more value to their appearance and that is the usual strategy normally seen. They can also style their hair by colouring to make the areas of thin hair look darker and thicker.

They can colour the scalp area with a darker shade of colour and colour the other areas of their hair with light shade of colour such that their hair appears uniformly thick.

Finally, some men embrace their inevitable fate of hair loss and decide to shave their hair completely and go fully bald. This is a good option especially for those who have tried most techniques and still not getting good results as this helps to prevent them worrying and stressing themselves about maintaining their hair.

It also adds psychological strength to them in their new look which appears more masculine to them and makes them feel stronger.

It is even a fact that bald men are predominantly more attractive to most or at least some women and thus it is not a bad idea to resort to this prominent and most effective technique to embrace physically and psychologically in hair management.

Conclusion (Summary)

To close down the chapter on this session of health discussion, we can say that hair loss cannot be entirely cured but it can be treated such that there can be a slowdown in the progression of the hair loss.

We also learnt the fact that most treatment options are only favourable for certain categories of individuals and hence there is the need for individuals to be certain they qualify to use a particular treatment option by assessment of the risk-benefit ratio.

References

1.  Brenner, F., Bergfeld, W. (2003). Hair loss: Diagnosis and management. Cleveland Clinic journal of medicine. 70. 705-6, 709. 10.3949/ccjm.70.8.705.

2.     https://www.everydayhealth.com/hair-loss/hair-loss-basics.aspx

      Retrieved on 26/02/2021 at 20:23 JST.

3.    Redler, S., Messenger, A.G., Betz, R.C. Genetics and other factors in the aetiology of female pattern hair loss. Exp Dermatol. 2017 Jun;26(6):510-517. doi: 10.1111/exd.13373. PMID: 28453904.

4.     https://thehairsociety.org/hair-loss-statistics-the-facts/

      Retrieved on 26/02/2021 at 20:32 JST.

5.     Headington, J.T. Telogen effluvium. Arch Dermatol 1993; 129:356–363.

6.   Kaufman, K.D., Olsen, E.A., Whiting, D., et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol 1998; 39:578–589.

7. https://bglh-marketplace.com/2013/10/how-to-use-sulfur-for-hair-growth/#:~:text=More%20exciting%20is%20that%20there%20are%20studies%20indicating,phase%20%28before%20resting%20and%20shedding%29%20means%20longer%20hair. Retrieved on 26/02/2021 at 21:10 JST.

WRITTEN AND EDITED RESPECTIVELY BY:

Pharm Alex Boateng - wapomu.com
Pharm. Alex Boateng
Research Pharmacist

MPSGH, MPhil., MPSJ

Pharm. Alex Boateng is a Pharmacist and member of the Pharmaceutical Society of Ghana (MPSGH since 2017). He was a demonstrator or Graduate Assistant (GA) at the Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences (FPPS) from 2016-2019 and he completed an MPhil Program in Pharmaceutical Chemistry in 2018.

He is currently a PhD Fellow at Sojo University, Kumamoto, Japan. He is pursuing a PhD course in the field of Molecular Design in Organic and Medicinal Chemistry and recently had some aspects of his PhD work published on Elsevier's Tetrahedron Letters. He is also a member of the Pharmaceutical Society of Japan (MPSJ) and the Chemistry Society of Japan (MCSJ) and has made a presentation on research updates in their Annual General Meetings or Conferences.

He is looking forward to being a Lecturer and a Research Pharmacist in the Academia.

Chief Editor at Wapomu.com

MPSGH, MRPharmS, MPhil.

Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.

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